The thesis attempted to explore the 'lived experience' of young people who have been through the care system, in order to ascertain what changes could be implemented to improve the psychological wellbeing of young people going into the care system in the future. After a brief introduction (chapter one), an evidence synthesis (chapter two) on young people who have been in residential care was conducted, to examine this phenomenon from an international perspective. A comprehensive search strategy produced fifteen studies, which were selected for final review. A process of data extraction and subsequent data synthesis of the fifteen studies yielded twelve themes. The developed themes included topics such as, for example, the quality of relationships: between the young people, the young people and the care staff and the wider community. The thesis then used an empirical research piece (chapter three) to narrow the focus of the topic to Ireland and to explore the views of young people in conjunction with the views of care workers. For this purpose, a convenience sample of twenty participants (ten residential care workers and ten young people who had been through residential care), completed a care questionnaire and an open-ended interview of one-hour duration. A thematic analysis was performed to comprehend the raw data. The thematic analysis of the dataset elicited fourteen themes; 2 young person themes, 3 care worker themes, and 9 joint themes. The developed themes addressed areas such as: 'fitting in,' 'what makes a care worker' and 'wider connected processes.' The findings were considered in light of other research literature in this area. Since many of the themes related to psychological wellbeing of young people in the care system, the Trauma Symptoms Checklist for Children - Alternate (TSCC-A) was chosen as a psychometric to be critiqued (chapter four). The: properties, normative data, reliability, validity and applicability of the measure were considered. In terms of applicability, how appropriate the measure is for use with young people in the care system was a salient issue. The TSCC-A was used to then assess levels of trauma and psychological wellbeing with the young person in the case study (chapter five). In contrast to the earlier chapters, chapter five looked at the care system in terms of secure institutional care (as opposed to residential care in the earlier chapters), which produced insights into the care establishment as a whole and emphasised aspects such as the importance of therapeutic milieu. D4 who was diagnosed with schizophrenia and committed acts of criminal damage and arson had an individualised care approach adopted with him. He was given pre and post psychometrics to chart the success of his time in care (pre and post intervention). The findings suggested that D4 had shown improvement towards his propensity for negative internalising and externalising behaviours and his psychological wellbeing overall had improved. Chapter six then attempted to consider many of the different insights offered by the preceding chapters and it ends by offering suggestions for how the psychological wellbeing for young people in the care system could be improved, through the amelioration of treatment integrity.

Background Awareness of the harmful effects of second-hand smoke (SHS) has led governments in the United Kingdom (UK) and many other countries to introduce smoke-free legislation in almost all enclosed work and public places. Her Majesty’s (HM) Prison Service, which currently holds over 85,000 offenders among whom the prevalence of smoking is high, was granted one of few exemptions from the 2007 smoke-free legislation in England, which allowed prisoners to smoke in their cells. This continued smoking impacts not only on the health of the individual smoker but also, through SHS exposure, on other smokers and non-smokers who live or work in the prison. However there is limited research evidence on levels of SHS in prison; how the current Prison Service Instruction (PSI) 09/2007 relating to smoking restrictions in prisons in England operates in practice and protects staff members and prisoners from SHS; or how feasible, acceptable or successful the extension of smoke-free policies to all areas of the prison are likely to be in preventing further exposure. Methods This thesis employs both quantitative and qualitative methods in a pragmatic mixed-methods design to investigate smoking and smoke-free policy in prisons in England. Initially, the concentrations of airborne particulate matter < 2.5 microns in diameter (PM2.5) were measured, as a proxy measure for SHS, in four English prisons. Samples were taken on wing landings and in smoking and non-smoking cells; and by ambient monitoring as a measure of personal exposure of staff working in these settings. Staff members who participated in this air quality monitoring study were then followed up to complete a one-to-one semi-structured qualitative interview exploring their views on smoking in prison and exposure to SHS, considering how the current PSI worked in practice, and the potential move to a smoke-free prison estate. A proposal to pilot test smoke-free policy in four prisons in England was announced shortly after, and in large part as a result of the findings of these first studies. A mixed methods evaluation of the new smoke-free policy was then conducted at all four sites, involving prisoner and staff questionnaires and focus groups, and air quality monitoring (sampling concentration of PM2.5 on wing landings) three months before and three months after the policy implementation date. Questionnaires and focus groups pre-policy were used to establish current smoking prevalence, investigate smoking practices and identify perceived problems and concerns regarding the move towards a smoke-free policy. Post-policy these methods were used to explore the impact of the smoke-free policy, views on its implementation alongside consideration of how it could be improved in the future. Concentrations of PM2.5 were used to determine whether going smoke-free reduced levels of SHS exposure. Results Initial air quality monitoring measured PM2.5 concentrations from 48 static locations and personal monitoring of 22 staff members. Arithmetic mean PM2.5 concentrations were significantly higher on landings where smoking was permitted in cells compared to completely non-smoking wings. Concentrations of PM2.5 on landings where smoking was permitted in cells often exceeding the World Health Organisation (WHO) upper air quality guidance limit for a 24 hour period. During personal monitoring of staff members, some of the highest concentrations of PM2.5 were recorded during duties such as locking or unlocking cells, handing out mail and cell searching. Qualitative interviews with prison officers who took part in air quality monitoring reinforced these air quality monitoring findings, confirming the times of the day and duties undertaken where they felt most at risk from SHS. Prison officers outlined how the current PSI was often unworkable day-to-day, conceding that prisoners would often ignore the smoking restrictions in place. In the evaluation of the first four pilot sites to go smoke-free in England, findings prior to the implementation reported 65% smoking prevalence amongst prisoners, and highlighted widespread concerns among staff members and prisoners that going smoke-free would lead to an increase in disorder, self-harm, drug use and trading of tobacco. After the introduction of the policy, prisoners reported an increase in disorder and drug use, but staff reports suggested that concerns were predominantly unfounded. Post-policy, 60% of smoking prisoners reported using some form of Nicotine Replacement Therapy (NRT) in an attempt to cut down or quit in advance of policy implementation, but many reported difficulty accessing cessation support, and found the electronic cigarettes purchased as a substitute for smoking unsatisfactory. Support for the future introduction of the smoke-free policy throughout the rest of the English prison estate was much higher among staff members (70%) than prisoners (23%). Only a quarter of former smoking prisoners stated that they would remain smoke-free once released or transferred to a smoking establishment. Prisoners and staff reported positive outcomes from the smoke-free policy, both reporting a cleaner and healthier environment to life and work. There was a 69% median and a 66% mean reduction in PM2.5 concentrations three months after smoke-free policy was introduced, compared to the same samples taken three months pre-policy, and these reductions were highly statistically significant in all four prisons (p < 0.001). Unintended consequences of the smoke-free policy included smoking alternative substances (such as the contents of NRT patches, tea leaves and lawn grass), the creation of a tobacco black market and related bullying and debt, and the smuggling of tobacco. Conclusions Smoking in prisons in England is a source of high SHS exposure for both staff and prisoners, and the current PSI allowing prisoners to smoke in their cells does not protect other prisoners or staff from SHS exposure. Introducing a comprehensive smoke-free policy in four prisons in England proved successful, achieving marked reductions in tobacco use, improved indoor air quality, and healthier living and working conditions. There are however lessons for wider implementation, particularly in relation to setting clear timelines, ensuring that prisoners can access cessation services in advance of policy implementation, consideration of electronic cigarette available, and other unintended factors. Where possible, these factors need to be addressed to safeguard the future successful implementation throughout the rest of the English prison estate.

International bodies and networks within occupational health and occupational health psychology have over the last years highlighted a pressing need to understand how research and best practices can be translated into sustainable business practice. To stimulate and support organisations in strengthening their psychosocial risk management there have been a number of initiatives, guidance and frameworks that focus on best practice principles for managing the psychosocial work environment (BSI, 2011; Leka, Jain, Cox & Kortum, 2011; WHO, 2010). An essential question is how the frameworks launched by international initiatives, frameworks and standards can be re-interpreted and adjusted to fit the language and systems of particular business contexts, such as that of the petroleum industry. To explore this issue, this research has looked at how an oil and gas company has integrated a sustainable and comprehensive system for managing psychosocial risk. This research has two aims. First, it explores how the oil and gas industry can develop and implement a psychosocial risk management system by applying research and best practice in a Norwegian oil and gas company, in order to raise awareness of how psychosocial risk management practices can be integrated into a company’s internal management system. Secondly, it aims at raising awareness and stimulate to the application and use of established knowledge at organisational and national levels in this area. In this sense, the ultimate aim of this research is to inform policy makers about what it takes to actually implement and integrate policy into company context and at the same time to promote a comprehensive approach to worker protection and the promotion of their health. In all, four studies describe aspects of how this integration process has evolved. The first study explored the development and testing of a performance indicator for psychosocial risk in the oil and gas industry (Bergh, Hinna, Leka, & Jain, 2014b). This resulted in the establishment of a proactive exposure psychosocial risk indicator automatically published in the internal organisational performance management system of the organisation. The second study assessed the relationship between the psychosocial risk indicator (PRI) and objective measures, such as installation weight, age and leakage sources, of health and major accident potential, such as hydrocarbon leaks (Bergh, Ringstad, Leka & Zwetsloot, 2014c). Results from the analysis showed that only the psychosocial risk indicator significantly accounted for variation in hydrocarbon leaks. Only partial support was found for the relationship between technical factors and hydrocarbon leaks on the basis of correlation analysis. The third study describes the development of an internal audit tool of the psychosocial work environment in the oil and gas industry, focusing on offshore units (Bergh, Hinna, Leka & Zwetsloot, 2016). Psychosocial risk auditing is a proactive method for monitoring the status of psychosocial factors influencing the risk of stress and ill-health. The last study considered available quantitative and qualitative risk data collected through the PRIMA method over the last 8 years in the organisation to explore specific and common psychosocial risks in the petroleum industry in particular (Bergh, Leka, Zwetsloot, 2017). The results from the analyses confirmed the hypotheses proposed in the study that there was a significant correlation between job resources, job demands and symptoms of work-related stress and that there were differences in psychosocial risk factors and symptoms of work-related stress onshore and offshore. Future research should focus on testing the methods and tools developed in this company. Moreover, research should explore how other companies can incorporate and implement established knowledge on psychosocial risk management.

Background: Unintentional injury in the home setting is the leading cause of mortality and morbidity among pre-school children in the UK. Multi-component, community-based intervention programmes are a recommended means of addressing injury. England operated a national home safety programme based on this approach from 2009 to 2011. The programme was targeted at high risk families and supported through national government funding. Little is currently known about the sustainability of injury prevention programmes, despite its relevance to public health planners and policy makers. Studies of programme sustainability in the global public health literature reveal an over-reliance on self-reported data from a single source and often under represent the target group perspective. Aim and setting of the current study: The current study aims to explore influences on the sustainability of a multi-component injury prevention programme targeted at high risk communities in England. Study design: The multiple case study design used qualitative methods to explore programme and contextual influences on sustainability in five sites. Multiple perspectives were considered including those of families in the target group and professionals involved in scheme delivery. Local, national and global public health policy documents were reviewed to understand the wider context for scheme sustainability and to corroborate research findings. Interviews with stakeholders in injury prevention policy at national and international level were undertaken to explore the conceptualisation of sustainability. Framework analysis was conducted within-case and to identify cross-case over-arching themes. The analytic framework, display matrices and production of case study profiles documented the analysis stages. ‘Thick description’ assists the consideration of transferability of findings to other settings. Principal findings: Little consensus was apparent in the conceptualisation of sustainability among policy makers. Although programme sustainability was seen as relevant to those agencies influential in policy development, this was not reflected in policy documents. Funding availability and a supportive local context for scheme delivery were identified as the two main conditions required for sustainability. Ongoing change within the national political and economic context in England challenged sustainability efforts of local schemes. Three key strategies to actively encourage sustainability were identified: programme adaptation; presence of a co-ordinator or champion and extending collaborative networks. The adoption of these varied in response to contextual changes over time. Ongoing benefits of the scheme were identified in all sites. These included improved safety practices reported by the target group and increased access to harder-to-engage families for scheme professionals. Programme components displayed differential levels of fidelity between and within sites over time. Based on the study findings, a conceptual framework for promoting the sustainability of community-based child injury prevention programmes is presented. Conclusions: This is the first study to comprehensively explore the sustainability of a community-based injury prevention programme in England. It has identified influences on sustainability that contribute to and support findings from other areas of public health. The proposal of a conceptual framework to promote sustainability within community-based child injury prevention programmes makes an original contribution to the field. Potential transferability of study findings suggests that public health gain may be increased by sharing the knowledge base between topics. The study identified considerable challenges to sustaining local public health initiatives amidst ongoing change in the wider political and economic environments. Educating practitioners and policy makers could improve understanding of sustainability and enhance the future prospects for local initiatives. It is therefore recommended that sustainability should form an integral part of the programme planning cycle for public health initiatives.

Background: Injuries are a leading cause of morbidity and mortality in children and young people (CYP) throughout the world and in the UK. Detailed estimates of the risk of specific injuries, namely fractures, thermal injuries and poisonings, are not available for CYP with specific medical conditions, such as epilepsy or attention deficit-hyperactivity disorder (ADHD) in the English primary care population. To date there has been no description of the recording of ADHD by general practitioners (GPs) in English primary care according to people’s area-level social deprivation and strategic health authority (SHA) region. Objectives: 1. To define a cohort of CYP with epilepsy from the UK primary care population. 2. To estimate the risk of specific injuries, namely fractures, thermal injuries and poisonings in CYP with epilepsy compared to CYP without epilepsy. 3. To define and describe the cumulative administrative prevalence of ADHD in CYP in English primary care overall and by age, sex, SHA region, deprivation and calendar time. 4. To estimate the risk of specific injuries, namely fractures, thermal injuries and poisonings in CYP with ADHD compared to CYP without ADHD. Methods: This thesis describes work conducted using a large primary care dataset (the Clinical Practice Research Datalink (CPRD)) containing GP medical records and, for a proportion, linked hospital records from the hospital episodes statistics (HES) database. Firstly, the CPRD was used to define a cohort of CYP with epilepsy and CYP without epilepsy. The GP medical records for this cohort were used to estimate the risk of fractures, thermal injuries and poisonings, in CYP with epilepsy compared to CYP without epilepsy. The rates of injuries were estimated by age and sex. For a proportion of people in this study, the effect on estimates of using linked hospital medical records in addition to the GP medical records was evaluated. Secondly, the administrative prevalence of ADHD recorded by GPs was defined for CYP in England by identifying a cohort of CYP in the CPRD with GP medical records linked to hospital medical records. The cumulative administrative prevalence of ADHD was estimated overall and by age, sex, SHA region, deprivation and calendar time. Thirdly, the GP medical records and linked hospital medical records for the cohort of CYP with ADHD was used to estimate the risk of fractures, thermal injuries and poisonings, in CYP with ADHD compared to CYP without ADHD. The rates of injuries were estimated by age, sex and deprivation. Findings: CYP with epilepsy are at greater risk of fractures, thermal injuries and poisonings compared to CYP without epilepsy. In CYP with epilepsy the incidence of fractures is 18% higher, thermal injuries is 50% higher and poisonings 147% higher than in CYP without epilepsy, with the increased risk being restricted to medicinal poisonings. Among young adults with epilepsy, aged 19 to 24 years, the incidence rate of medicinal poisoning is four-fold that of the general population of the same age. Using GP medical records and linked hospital medical records may improve the ascertainment of injuries. For example, if hospital medical records are used in addition to GP medical records to ascertain femur fractures, a further 33% of fractures may be ascertained compared to using GP medical records alone. In comparison, if hospital medical records were used without GP medical records, 10% of femur fractures may not be ascertained. However, this increased ascertainment of injuries is unlikely to alter the estimates of risk of injuries in people with epilepsy when compared to people without epilepsy (e.g. risk of long bone fractures: using hospital and GP medical records, hazard ratio (HR)=1.25 (95% confidence interval (95%CI) 1.07 to 1.46) vs. using GP medical records alone, HR=1.23 (95%CI 1.10 to 1.38)). The administrative prevalence of ADHD in CYP aged 3 to 17 years old in English GP medical records is 0.88% (95% confidence interval (95%CI) 0.87 to 0.89). The prevalence of ADHD recorded by GPs is around five times greater in males than in females. The administrative prevalence of ADHD appears to increase with age, with the lowest prevalence in 3 to 4 year-olds (0.02 (95%CI 0.02 to 0.03)) and the highest prevalence in 15 to 17 year olds (1.38 (95%CI 1.36 to 1.40)). The administrative prevalence of ADHD is twice as high in CYP from the most deprived areas compared to CYP from the least deprived areas (1.14% (95%CI 1.12 to 1.16) in the most deprived areas to 0.64% (95%CI 0.63 to 0.65) in the least deprived areas)). CYP with ADHD are at greater risk of fractures, thermal injuries and poisonings compared CYP without ADHD. In CYP with ADHD the incidence of fractures is 28% higher, thermal injuries is 104% higher and poisonings is 300% higher than in CYP without ADHD. Conclusions: CYP with epilepsy and ADHD have an increased risk of fracture, thermal injury and poisoning compared to CYP without these conditions. For both conditions the risk of poisoning is higher than the risk of fractures or thermal injuries. The administrative prevalence of ADHD is lower than estimates of community prevalence ascertained from studies not using primary care data. The prevalence of ADHD varied with deprivation, being almost twice as high in CYP from the most deprived areas compared to CYP from the least deprived areas. Future research is required to explore the circumstances surrounding injuries in CYP with and without epilepsy and ADHD. Future research is also required to explore the effect of treating epilepsy and ADHD with medication on injury risk. Research is required to explore the effect of the severity of epilepsy and ADHD on estimated risks of injuries. Future research exploring potential under-diagnosis or under-recording of diagnosis of ADHD in CYP in primary care is needed. CYP with epilepsy and ADHD and their parents should be provided with evidence-based injury prevention interventions because work in this thesis has demonstrated they are at higher risk of injury than the general population of CYP. Health care professionals working with CYP; child and adolescent mental health services; child education or care practitioners; and other agencies and organisations with an injury prevention role, should be made aware of the increased risk of injury in CYP with epilepsy and ADHD. Commissioners of health services for CYP should ensure service specifications include injury prevention training and provision for evidence-based injury prevention interventions.

Background Harmful use of alcohol is the fifth leading risk factor for global burden of disease, disability and death. While the level of alcohol consumption varies around the world, it causes numerous preventable health and social issues in many countries and around 3.3 million deaths per year globally. In the UK alcohol consumption is decreasing; by contrast, alcohol consumption in Sri Lanka has been rapidly increasing over recent years. However, in both settings alcohol misuse represents a major public health concern. Therefore, it is important to evaluate existing alcohol control policies or contextual factors affecting alcohol consumption in these settings and to identify existing data sources that can be used for alcohol control policy evaluation. This thesis aimed to investigate the suitability of existing data sources in the UK, identify potentially suitable measures and use those measures to evaluate the impact of Licensing Act 2003 in England, which allowed flexible opening hours including 24-hour drinking at on-trade premises in England and Wales from November 2005 onwards. This thesis further aimed to apply the lessons learned from the UK to Sri Lankan context, identifying potential data sources and using these to evaluate the effect the end of conflict in 2009 on alcohol consumption in Sri Lanka. Methods A range of sources of data on alcohol consumption and consequences in the UK were reviewed to identify those appropriate for alcohol control policy evaluation, and in particular for time series analysis which requires consistent data collected at regular intervals for a long period of time. The suitability of UK primary care data on alcohol consumption was assessed by identifying the proportion of patients with a record of alcohol consumption status in the last year, as well as ever since their registration with a practice. The quality of alcohol consumption measures collected by English national surveys was assessed by comparing them with the international guidelines for measuring alcohol consumption in population surveys. Existing data sources on alcohol consumption and consequence in Sri Lanka were also identified and reviewed to identify their suitability for alcohol control policy evaluation. Interrupted time series analysis was then conducted on these measures to establish the effect of the Licensing Act 2003 on alcohol consumption among adults (age≥16) in England, and the end of the conflict on recorded alcohol consumption among adults (age≥15) living in the areas that were not directly affected by the conflict in Sri Lanka. Findings In the UK, there are numerous sources of alcohol consumption and consequence data. However, few provide frequently collected data from large samples over long time periods for time series analysis. The recording of alcohol consumption in primary care remains low, particularly when recent recording within a given year is considered. Moreover, alcohol consumption recording in primary care is higher among at-risk groups such as women in child bearing age, older men and women who are likely to have an illness linked to alcohol. Therefore, primary care data are currently unsuitable for alcohol control policy evaluation. Comparison of the alcohol data collected in English national surveys with recommendations from international guidelines showed that they have failed to maintain the consistency of data collection over time and to collect information on some of the key alcohol consumption measures such as the frequency of binge drinking. However, Health Survey for England (HSE) measured alcohol consumption on the heaviest drinking day of the last week consistently over time and this measure was available on a quarterly basis for a nationally representative sample. Interrupted time series analysis of HSE heaviest drinking day data from 2001 to 2013 showed that prior to the implementation of the Act alcohol consumption among adult male and female drinkers remained constant at around 8.3 units and 5.5 units of alcohol respectively. After the Act, there has been a gradual decline (less than 0.03 units per quarter) in the heaviest drinking day consumption among both male and female drinkers in England. However, it is difficult to attribute this decline in consumption to the Licensing Act as there was no step change in the consumption soon after the Act and the decline in heaviest drinking day consumption was small and gradual over a period of seven years. When compared with the UK, Sri Lanka has a limited number of data sources on alcohol consumption and alcohol consequences. The Department of Excise alcohol sales database was identified as the only data source that can be used for alcohol control policy evaluation in Sri Lanka. However, these population-level data cannot be used to identify the characteristics of people who drink and patterns of drinking such as binge drinking. Interrupted time series analysis showed that recorded alcohol consumption among Sri Lankans living in areas that were not directly affected by the armed conflict increased markedly after the end of the conflict in 2009, with a dramatic acceleration in the trend of adult per capita consumption. Annual adult per capita alcohol consumption among Sri Lankans increased from 1.59 litres of pure alcohol in 1998 to 2.56 litres of pure alcohol in 2013. Prior to the end of war in 2009 adult per capita alcohol consumption was increasing by 0.051 litres of pure alcohol per year (95% CI 0.029-0.074, p < 0.001). After 2009, it increased by 0.154 litres per year (95% CI 0.082-0.226, p=0.001). it increased by 0.166 litres of pure alcohol per year (95% CI 0.095-0.236, p < 0.001), almost a three-fold increment in the increase per year compared to the trend prior to the end of the conflict. Beer consumption showed the highest per capita growth compared with other beverages. Conclusions This thesis identified the existing data sources that can be used for alcohol control policy evaluation purposes in two settings; UK and Sri Lanka. It has highlighted the further improvements required in existing alcohol consumption related data sources in both countries and discussed the potential of applying lessons learned from the UK context to Sri Lankan context. Despite the current trend in alcohol consumption, both countries experience a significant public health burden due to alcohol misuse. Therefore, both countries will require formulation and implementation of new policy measures. However, Sri Lanka does not have high-quality individual level alcohol consumption data to support the monitoring and evaluation of alcohol control policies. Therefore, this thesis has emphasised the need to generate high-quality alcohol consumption data in Sri Lanka and carry out monitoring and evaluation of alcohol control policies to tackle the alcohol-related burden.

Background: South Asians constitute the single largest ethnic minority group in the United Kingdom, yet little is known about their perspectives and experiences on end of life and its related care. Aim: To explore and critically examine views and perceptions about end of life issues among older South Asians living in East London. Methodology and methods: After gaining ethical approval, five focus groups and 29 in-depth, semi-structured interviews were conducted with total of 55 older adults (24 men and 31 women) aged between 52 to 78 years. Participants from six South Asian ethnic groups were recruited through 11 local community organisations. Where possible the focus groups and interviews were conducted in the participants' preferred language. Tape recorded multilingual data were translated and transcribed into English. Using a constructive grounded theory approach, data analysis resulted in the development of a theory of “continuity and reconstruction” that captured three categories of ‘home’; ‘family’ and ‘trust’ at end of life. Findings: The theory of “continuity and reconstruction” is explored in three ways. Firstly, the theory is explored through examination of beliefs, attitudes and expectations about the place of ‘home’ and ‘homeland’ in care of the dying. Secondly, the theory is explored as accounts of “family” in terms of how family are bound towards caring for their dying relatives at end of life and the importance of support from social networks in family care giving. Finally, the theory is explored in terms of how participants place “trust” in their family and medical professionals to lead any related discussion and to make decisions related to their death and dying. Conclusion: The theoretical framework of “continuity and reconstruction” explains how older South Asians make efforts to adhere to important social and cultural values relating to death and dying, while rebuilding and adapting those values during the challenges of living in an emigrant society. This study highlights the need for further exploration of family care giving needs among South Asian population and concludes by drawing attention to some practical implications for health professionals who are responsible for initiating end of life discussions and are involved in end of life decisions when caring for people from these ethnic minority groups.

This thesis presents a pluralistic evaluation of the services provided for women with long-term mental health problems receiving care and support within the Rehabilitation and Community Care Service (RCCS) in Nottingham. The thesis is grounded in data collected within an evaluative research framework and developed within a mental health policy framework. The evaluation consists of a series of six studies which are informed by a set of evaluation criteria which reflect a range of stakeholder perspectives. The first study examines the socio-demographic and psychiatric characteristics, social functioning and service use of all 480 clients registered with the RCCS. The clients' characteristics are similar to those described in previous studies. There are some• differences between the men and the women, notably that the women are under-represented amongst those receiving a high level of input from the services. The second and third studies explore the extent and adequacy of services for women with long-term mental health problems in the Nottingham district through interviews with small groups of service providers working throughout the RCCS, and through a postal questionnaire to thirty eight organizations outside the RCCS. Special provision made for women is patchy, and there is no overall strategy to ensure even provision throughout the RCCS and the organizations outside the service, or co-ordination between them. The fourth study assesses the initial socio-demographic and psychiatric characteristics, social functioning, satisfaction with services, and quality of life of 31 men and 10 women at their time of entry into the RCCS and one year later, and their use of all services during this time. The women experienced a greater number of life events than the men, changed their accommodation more frequently, and the services appear to be less responsive to their particular needs. The outcome after twelve months shows that overall the social functioning and quality of life of the clients had not improved. There were some changes in service use, notably the greater number of clients living independently. The fifth study uses semi-structured interviews to explore the problems service providers experience in planning and delivering a service to women with long-term mental health problems. Two overriding themes emerge from the data; service providers as empathic women, and service providers as professionals, which lead them to experience a conflict between respecting the rights of women with long-term mental health problems and protecting them. The final study uses focus groups to explore the impact of mental health problems on the lives of women with long-term mental health problems, and their views of the services they currently receive. Three themes emerge from the data; loss, hope and views about services. Despite overwhelming losses many of the women retain hopes and aspirations for the future. The women identify negative and positive aspects of the services they are receiving together with some recommendations for change. The thesis contributes to current knowledge about the experiences of women with long-term mental health problems in a number of ways. First, the findings of the six studies which make up the evaluation highlight the ways in which the RCCS was successful in meeting these women's needs, and the many gaps in existing provision. Second, women with long-term mental health problems can give coherent and comprehensive accounts of their experiences. Third, the findings illuminate the current predicament of women with long-term mental health problems which is that they remain excluded and marginalised from the communities where they are now living.

Psychological research on expatriation has been dominated by North American researchers, and expatriation models have been tested using predominantly US employee samples. This dominance may bias our understanding of expatriation and influence the practice of expatriate assignments within organisations. This thesis addresses the need for European expatriation research, and investigates expatriate assignment success from a British employee perspective. A sequential mixed-methods design was used to examine whether existing knowledge on predictors for successful expatriate assignments can be generalised to British samples. The first phase of the research was a qualitative exploration of factors that contribute to expatriate assignment success from the British employee perspective. Four focus groups were conducted with formerly expatriated British employees (n=14). An inductive thematic analysis was conducted on the focus group transcripts, which resulted in nine themes highlighting the importance of individual, organisational, and contextual-level variables. Moreover, the analysis highlighted an important outcome variable that has been largely ignored in previous research: whether or not the employee would go on another expatriate assignment. From the results of phase one, an initial model of British expatriate assignment success was hypothesised. Phase two involved the practical application of the variable considered most important in contributing to expatriate assignment success from study one: personality. A new expatriate assignment personality instrument was developed in phase two using a sample of British employees (n=402). The third phase of the research combined the results of the previous two phases, and employed an embedded mixed-methods design to further investigate British expatriate assignment success. Data (n=155) was collected using an online questionnaire sent to currently expatriated (n=91) and formerly expatriated British employees (n=45), as well as their accompanying partners (n=19 expatriate/partner dyads). The quantitative element explored the influence of several individual, organisational, and contextual variables on various expatriate assignment success outcome measures. Qualitative data was also collected through open-ended questions placed within the questionnaire to help explain and support the quantitative results, and identify potential areas for future research. Finally, the newly developed personality instrument from phase two was further examined for psychometric robustness. Overall, this thesis presents an initial model of British expatriate assignment success and a new personality instrument for British expatriate selection and assessment contexts. The theoretical and practical implications of these results are discussed together with suggestions for future research.

The present thesis was conceptualised and conducted against the backdrop of rapidly emerging research that challenges the conventional depiction of OCBs as positive extra-role behaviours that produce beneficial outcomes to both individuals and organisations. The thesis contends that OCBs may be either beneficial or detrimental to individual performers depending on their perceptions of the psychosocial work environment – i.e. perceived job control and perceived organisational support. Both perceived job control and organisational support have been researched in existing theoretical models and prior research which depict and assess these variables as key moderators in the relationship between work stressors and job strain. Hence, the present thesis hypothesised that both job control and support will moderate the effects of Time 1 OCBs (peer reports of OCB-I and OCB-O) on various individual-level outcomes of job satisfaction, organisational commitment, role ambiguity, role overload, work-family conflict, physical exhaustion and work-related depression measured at Time 2, based on a two-wave longitudinal panel methodological design. This newly proposed moderation model was tested across three interrelated Studies (Study 1, Study 2, and Study 3) in which the first two studies were cross-sectional based on Time 1 and Time 2 data, respectively, and the final study provided a longitudinal version of the same analyses. A direct effects model (where the effects of Time 1 OCBs on the Time 2 outcomes were assessed) and a mediation model (in which role stressors were modelled as mediators between OCBs and job attitudes and health) were also examined, alongside the proposed moderation model. In Study 1, based on data from 562 employees in Barbados captured at the first wave, structural equation modelling (SEM) analyses revealed that the direct effects model emerged superior to the mediation and moderation models. There were no significant interaction effects of control and support on any of the outcomes in Study 1. In Study 2, based on data from 427 employees (an attrition rate of 24%) captured at the second wave, the SEM analyses revealed that both mediation and moderation models emerged as the superior models. In the moderation model, both control and support emerged as significant moderators in several relationships between OCBs and the outcome variables. Finally in Study 3, the longitudinal SEM analyses revealed that the ‘normal causation’ direct effects model emerged superior to the reverse and reciprocal causation models as well as the mediation models. The moderation model also emerged as a superior model in which both control and support moderated several relationships between Time 1 OCBs and Time 2 outcome variables. Overall, the present thesis provided some support for the proposed moderation model and is consistent with key assumptions underlying existing theoretical models and findings of prior research on the stressor-strain relationship. The findings reinforced the role of personal job resources such as job autonomy and organisational support as critical factors that can buffer the potentially negative effects of OCBs for individual performers. Theoretical and practical implications, future research recommendations, and study limitations have been discussed in the final chapter of the thesis.